NORTHWESTERN UNIVERSITY
Claude D. Pepper Older Americans Independence Center

Michael S Wolf, PhD, MPH
Principal Investigator		   312-503-5592   mswolf@northwestern.edu
Jeffrey A. Linder, MD, MPH
Principal Investigator		   312-503-6202   jlinder@northwestern.edu
Julia Benavente
Center Manager		   312-503-5585   julia.benavente@northwestern.edu
     
CENTER DESCRIPTION

The Northwestern Pepper Center’s mission is to improve primary care management of older, more medically complex adults living with multiple chronic conditions (MCC). We will identify and train future leaders in geriatrics and gerontology research through mentorship, sharing of resources, and pilot projects. The training emphasizes care for older adults with MCC, as they are at higher risk of poor outcomes and costly care.

The specific aims of the Northwestern Pepper Center are to:

Aim 1 Formalize a comprehensive, multidisciplinary, aging research program dedicated to improving healthcare, functional independence, and quality of life for older adults with MCC. 

We will unite internationally recognized geriatricians and aging research faculty to establish a formal presence as a collaborative center promoting new investigations around improving the primary care management, and overall health of medically complex older adults with MCC. Through an Information Dissemination Core, the Northwestern OAIC will leverage broad local, regional and national primary care networks to rapidly translate research findings, share evidence-based practices, and support their implementation. 

Aim 2 Expand Northwestern training and mentoring activities to develop future leaders in geriatrics and aging research who will transform healthcare to meet the needs of older adults with MCC. 

Junior faculty and fellows across multiple disciplines who have aging and MCC-related research interests will participate as mentored scientists within our OAIC, working closely with affiliated faculty to establish a successful career trajectory to becoming independent investigators. Our linked Research Education and Pilot/Exploratory Studies Cores, supported by three Resource Cores will provide trainees with substantive & methodological mentorship and extensive research opportunities through relevant External, Developmental and Pilot Projects.

Aim 3 Stimulate applied research on the innovative design of primary care models that align with the priorities of older adults with MCC through aging-specific research resources and expertise in healthcare system & technology design (‘Design Core’), patient-reported outcomes measurement (‘Measurement Core’) and quantitative & qualitative data analytics (‘Analytics Core’).

The Northwestern OAIC will provide 3 essential Resource Cores (Design, Measurement, Analytics) to support MCC-related Developmental Projects, such as: 1) developing multifaceted, technology-enabled interventions to promote clinician adherence to best practices in the management of older adults with MCC, and supporting older patients and their caregivers’ engagement in primary care and self-management of MCC; 2) the routine collection of patient-reported outcomes and priorities in primary care to improve clinical decision making; 3) developing assessment tools to quantify patients’ disease burden, treatment burden and overall medical care complexity for purposes of risk stratification; and 4) new methodological approaches to data harmonization across healthcare systems to better capture older adults’ health and frailty status. We will also seek out new MCC-related investigations through our Pilot/Exploratory Studies Core and an extensive portfolio of ongoing External Projects. 

CORES
Leadership & Administrative Core (LAC)
Leader 1:    Michael S. Wolf, PhD, MPH   mswolf@northwestern.edu
Leader 2:    Jeffrey A. Linder, MD, MPH   jlinder@northwestern.edu
Leader 3:    Lee Lindquist, MD, MPH, MBA   lal@northwestern.edu

The Leadership/Administrative Core (LAC) oversees the daily operations of the Northwestern OAIC and the implementation of its mission, coordinating activities amongst all of the center Cores and organizational partners from the community, government, healthcare system, industry and other academic institutions. 



Research Education Core (REC)
Leader 1:     Sara M. Bradley, MD   sara.bradley@northwestern.edu
Leader 2:    Allen Heinemann, PhD   a-heinemann@northwestern.edu
Leader 3:    June McKoy, MD JD MBA   j-mckoy@northwestern.edu

The Research Education Core (REC) is the mentorship arm of the OAIC, developing programs to assess the formative needs of Pepper Scholars and provide them with personalized educational, career development, and networking opportunities to facilitate their research.



Pilot/Exploratory Studies Core (PESC)
Leader 1:    Mary McDermott, MD   mdm608@northwestern.edu
Leader 2:    Emily Rogalski, PhD   e-rogalski@northwestern.edu

The Pilot/Exploratory Studies Core (PESC) is a primary home to our OAIC's scientific and scholarly training, responsible for the review and selection of at least 15 pepper scholars and 12 pilot project funding recipients and overseeing their progress throughout the award period.



Healthcare System & Technology Design Core (Design Core)
Leader 1:     David C Mohr, PhD   d-mohr@northwestern.edu
Leader 2:    Rachel Kornfield, PhD   rachel.kornfield@northwestern.edu
Leader 3:    Andrew Berry, PhD   andrew.berry@northwestern.edu

The Healthcare System & Technology Design Core provides expertise to junior investigators, Core and National Pepper Center Network faculty in the design, development, evaluation, and implementation of technology-enabled services for older adults with MCC. 



Information Dissemination Core (IDC)
Leader 1:    Ron Ackermann, MD, MPH   r.ackermann@northwestern.edu
Leader 2:    David Liebovitz, MD   davidl@northwestern.edu

The Information Dissemination Core (IDC) distributes research findings through an array of communication channels to patients, families, care practices and policymakers. The IDC also solicits ideas from stakeholders to inform the development of new research projects and products.



Patient-Reported Outcomes Measurement Core (Measurement Core)
Leader 1:     David Cella, PhD   d-cella@northwestern.edu
Leader 2:    Daniel K Mroczek, PhD   daniel.mroczek@northwestern.edu
Leader 3:     Eileen Graham, PhD   eileen.graham@northwestern.edu

The Patient-Reported Outcomes Measurement Core provides measurement expertise for the entire Northwestern OAIC and national Pepper Center Network and serves as a resource to the Research Education Core for junior faculty seeking skills in measurement and the deployment of tools in primary care.



Quantitative and Qualitative Data Analytics Core (Analytics Core)
Leader 1:     Leah Welty, PhD   lwelty@northwestern.edu
Leader 2:     Kenzie Cameron, PhD, MPH   k-cameron@northwestern.edu
Leader 3:    Laura Curtis, MS   l-curtis@northwestern.edu
Leader 4:     Mary Kwasny, ScD   m-kwasny@northwestern.edu

The Data Analytics Core provides expertise on quantitative and qualitative research design and analytic methods supporting affiliated faculty, cores, and pilot projects, while developing new methods for determining older adults’ health status to better inform clinical decision making.
CAREER DEVELOPMENT
REC Scholar, Research & Grants Funded During Pepper Supported Time Years /
Publications
 
Diana Chirinos, PhD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine (Epidemiology)
Differential Associations Between Spousal Bereavement, Physical Functioning, and Health Outcomes Among White and Latino Older Adults
 2023-2025 /
19 (total)
5 (1st/Sr)
 
Allison Pack, PhD
Research Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics)
Adaptation and Pilot Testing of the Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) Study
 2022-2024 /
3 (total)
1 (1st/Sr)
 
Daniel Rees Lewis, PhD
Research Assistant Professor / Northwestern University, Segal Design Institute & Mechanical Engineering
Leveraging Human-Computer Interaction and Learning Sciences to Support Older Adults’ Use of Telehealth Software for Chronic Disease Self-care
2022-2024 /
15 (total)
5 (1st/Sr)
 
Minjee Kim, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Neurology
Technology-Enabled Screening Strategy for Obstructive Sleep Apnea (TEST-OSA) in Primary Care Older Patients with Multiple Chronic Conditions
 2022-2024 /
6 (total)
4 (1st/Sr)
 
Kelly Jarvis, PhD
Research Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Radiology
Heart-brain MRI evaluation of hemodynamic coupling in hypertension and healthy aging
  • Heart-brain MRI for the evaluation of hemodynamic coupling in aging and Alzheimer’s disease (1K01AG080070)

 2022-2024 /
1 (total)
0 (1st/Sr)
 
Prakash Jayabalan, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation
The Development of Novel Therapeutic Walking Exercise Strategies in Sedentary Individuals with Knee Osteoarthritis
 2022-2024 /
5 (total)
1 (1st/Sr)
 
Emi C. Bretschneider, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology (Female Pelvic Medicine and Reconstructive Surgery (Urogynecology))
Ready for Advances in Bladder health for Older Women (The RAInBOW Study)
 2022-2024 /
11 (total)
3 (1st/Sr)
 
Past Scholars
Rachel O'Conor, PhD, MPH, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2020-2022)
Miriam Rafferty, DPT PhD, Northwestern University, Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation (2020-2022)
Katherine O’Brien, MD, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2020-2022)
Theresa Rowe, DO MS, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2020-2022)
Sadiya Khan, MD MSc, Northwestern University, Feinberg School of Medicine, Department of Medicine (Cardiology) and Department of Preventive Medicine (Epidemiology) (2020-2022)
Marquita Lewis-Thames, PhD, Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences (2021-2023)
Whitney Welch, PhD, Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine (Behavioral Medicine) (2021-2023)
Emma L Barber, MD, Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology (Gynecologic Oncology) (2021-2023)
Mary Clare Masters, MD, Northwestern University, Feinberg School of Medicine, Department of Medicine (Infectious Diseases) (2021-2023)
Rebecca Lovett, PhD, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2021-2023)

PILOT/EXPLORATORY PROJECTS (9 Pilot Projects Listed)
1. Project Title: Prevalence of microvascular dysfunction and association with functional limitation in older adults with chronic obstructive pulmonary disease
  Leader: Sadiya Khan, MD, MSc
 

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are major public health epidemics and commonly coexist in older adults (65+ years). Broadly, cardiovascular causes account for 50% of all deaths in patients with COPD. Specifically, 1 in 3 patients with COPD also have prevalent HF, and this associated with greater functional intolerance, worse health-related quality of life, and increased healthcare expenditures compared with patients with COPD and without HF. Given the high burden of mortality and morbidity with comorbid COPD and HF, identifying key risk factors to prevent functional decline related to HF risk in older adults is critically important. Therefore, we propose an observational, cross-sectional study in older adults (?65 years) with COPD who have no known history of coronary artery disease or heart failure to examine cross-sectional associations between severity of COPD and microvascular dysfunction, functional status with 6-minute walk test, dyspnea symptoms, and cardiac biomarkers.

The specific aims of this pilot are: (1) Determine the cross-sectional association between severity of COPD (GOLD Stages) and microvascular dysfunction; (2) Determine the cross-sectional association between severity of COPD (GOLD Stages) and 6-minute walk test, patient reported outcome for dyspnea, and cardiovascular biomarkers.
 
2. Project Title: Designing a Telehealth-Based Tool for Rural Older Adults with Cancer and Cancer-Related Distress: Testing for Usability and Acceptability
  Leader: Marquita Lewis-Thames, PhD
 

Older adults have difficulties identifying symptoms of anxiety and reduced likelihood of knowing when to access mental health services. One in four adults >65 years old lives in a rural or small town, where mental health specialists and similar resources are often dispersed or located in distal urban centers. To this end, rural older adults with cancer-related anxiety or distress (CRD) are particularly vulnerable to poorer mental health and cancer-related outcomes. This project proposes a strategy to improve CRD outcomes for rural older adults via a telehealth–based program that supports the management of CRD by integrating clinical and community-based resources.

The specific aims of this pilot are: 

Aim 1: Assess barriers and facilitators of telehealth access from rural older cancer patients, caregivers, and healthcare professionals to guide the development of a telehealth delivered CRD management tool.

Aim 2: Develop a theoretically-grounded telehealth CRD management tool using a human-centered design.

Aim 3: Conduct user testing to inform the final version and an intervention protocol to test the implementation an effectiveness of the telehealth CRD management tool.
 
3. Project Title: Adaptation and Pilot Testing of the Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) Study
  Leader: Allison Pack, PhD
 

We will adapt and pilot test a technology-enabled, primary care strategy for routinely monitoring medication use and adherence among older adults with multiple chronic conditions and polypharmacy. An ongoing Northwestern trial (‘TAKE IT’; R01DK110172) has been able to leverage an electronic health record (EHR) platform and its linked patient portal (Epic, MyChart [MyNM]) to: 1) routinely engage new adult kidney transplant recipients via monthly portal-based adherence assessments; 2) flag and phenotype reported adherence concerns; 3) alert care teams via secure messaging of the specific adherence concern(s); and 4) mobilize available resources tailored to identified barriers (e.g. SMS text reminders for cognitive barriers, a comprehensive medication review via phone or video telehealth to address regimen complexity, social work referral for social or economic concerns, etc.) following a standard protocol. With this award, we will adapt the TAKE IT strategy for use in primary care, targeting older adults with MCC and polypharmacy (using Medicare Part D medication therapy management criteria of ?8 medications). This intervention, renamed as the PATTERN study (Phenotyping Adherence Through Technology-Enabled Reports and Navigation) will then be pilot tested at one Northwestern Medicine (NM) primary care practice to determine its acceptability, feasibility, and preliminary fidelity.

The specific aims are:

Aim 1: Adapt the PATTERN intervention for use in primary care using input from key stakeholders.

Aim 2: Assess the PATTERN intervention’s feasibility and acceptability for use in primary care.
 
4. Project Title: Leveraging Human-Computer Interaction and Learning Sciences to Support Older Adults’ Use of Telehealth Software for Chronic Disease Self-care
  Leader: Daniel Rees Lewis, PhD
 

There is currently a gap between the existing and needed clinical support to help older adults learn to manage their conditions. The current system of care does not help patients with chronic conditions (e.g., diabetes) learn effective self-care, and there are few programs developed for older adults. Consequently, there is increased pressure on primary care clinicians, who must help teach older adults to manage their conditions in just a few short minutes they have to meet. This project will seek to leverage Human Computer Interaction (HCI) and Learning Science (LS) methods and designs to create telehealth supports for older adults responsible for learning to manage their own health. I will focus on older adults with type II diabetes, and at least one of hypertension and high cholesterol. While older adults can find software challenging, HCI research shows by attending to their needs we can help them effectively use software (Brewer et al., 2016). Helping older adults to better use telehealth can increase learning and improve health outcomes for older adults while reducing the burden on primary care.

Aim 1: Use cognitive task analysis (CTA) methods to understand the barriers older adults have when using telehealth for self-care management.

Aim 2: Apply findings from Aim 1 to design a learning module to support using existing diabetes telehealth software and then engage in iterative redesign for and with older adults.
 
5. Project Title: Technology-Enabled Screening Strategy for Obstructive Sleep Apnea (TEST-OSA) in Primary Care Older Patients with Multiple Chronic Conditions
  Leader: Minjee Kim, MD
 

We will adapt and pilot test a technology-enabled, primary care strategy to promote the timely detection and treatment of sleep apnea among older adults at high risk due to multiple chronic conditions.

Obstructive sleep apnea (OSA), characterized by repeated episodes of upper-airway obstruction during sleep, is estimated to affect up to 35% of older adults 65 and older, yet it is vastly underdiagnosed. Undiagnosed and untreated OSA is associated with an increased risk for incident hypertension, coronary heart disease, heart failure, stroke, and mortality, as well as increased motor vehicle crashes, mood disorders and reduced quality of life. OSA is a leading cause of sleep disturbance in older adults and has been linked to more rapid accumulation of chronic diseases and multimorbidity.

Many approaches have been taken to improve primary care detection of OSA, yet evidence has been highly variable with regard to the acceptability, feasibility, and effectiveness of what has been recently summarized as a range of ‘fragmented’ interventions not limited to high-risk older adults. Yet with widespread use of electronic health records (EHR), there are opportunities to overcome existing screening barriers, streamline clinical workflows, and activate care teams to enable the timely diagnosis of OSA and initiation of appropriate treatment. With this Pepper Scholar application, I will model an existing intervention (Toolbox Detect; R01AG069762) leveraging consumer technology (iPad), tethered to the EHR for routinely screening for cognitive impairment as part of Medicare Annual Wellness Visits (AWV), for use in the early detection of OSA among high-risk adults meeting AHA criteria or with MCC. This Technology-Enabled Screening Targeting Obstructive Sleep Apnea (TEST-OSA) strategy will promote the primary care detection and treatment of OSA among high-risk adults.

It is hypothesized that TEST-OSA, compared to usual care, will increase timely diagnosis of OSA and treatment initiation, without added burden to clinicians. My specific aims are to:

Aim 1 Develop and refine the TEST-OSA primary care strategy for high-risk older adults, including those with MCC using input from key stakeholders.

Aim 2 Pilot Test the TEST-OSA strategy to determine its acceptability, feasibility, and fidelity in primary care and explore any patient, provider, or health system barriers to implementation.
 
6. Project Title: Heart-brain MRI evaluation of hemodynamic coupling in hypertension and healthy aging
  Leader: Kelly Jarvis, PhD
 

Cardiovascular risk factors, such as hypertension and physical inactivity, are among “potentially modifiable” dementia risk factors that can be influenced in mid to later life. However, mechanisms underlying heart-brain hemodynamic coupling are not well understood. In order to successfully inform new approaches for preventing, delaying or improving quality of life for those suffering from multiple chronic conditions of the heart and brain, interactions between these two major organs need to be further explored.

MRI is an established diagnostic tool for assessing cardiovascular function and neuroimaging markers of cerebrovascular disease and neurodegeneration. In the past decade, 4D flow MRI has emerged as a powerful technique for measuring 3D hemodynamics in the heart and brain vessels. Previously, I developed imaging tools for visualization and quantification of cardiovascular hemodynamics, demonstrating the comprehensive and individualized analysis of complex flow pathways. Using these techniques, I found significant age-related changes in aortic stiffness assessed by pulse wave velocity (PWV). Results in 100 healthy controls (19-79 years) showed a strong correlation with age (r=0.79, p<0.001). Next, will be to study how these changes interact with cerebrovascular hemodynamics and neuroimaging markers of disease.

Abnormalities in heart and brain regions, however, have been historically assessed independently in scanners dedicated for either cardiovascular or neuroimaging studies. Recent developments in MRI provide the ability to image faster and thus an opportunity for integrating cardiovascular 4D flow MRI with neuroimaging in a single patient exam. I have designed a preliminary “heart-brain MRI” protocol and acquired pilot data in 12 healthy individuals (age: 24-76) to demonstrate feasibility (Jarvis et. al. ISMRM abstract 2022). This novel approach will be used for comprehensive assessment of heart-brain coupling in an initial study of cognitively healthy adults.

AIM: Apply novel heart-brain MRI methods in study of hypertension and normal cognitive aging.

a. Establish normative heart-brain MRI values and quantify interactions across adult lifespan.

b. Evaluate potential impacts of hypertension on hemodynamic coupling.
 
7. Project Title: The Development of Novel Therapeutic Walking Exercise Strategies in Sedentary Individuals with Knee Osteoarthritis
  Leader: Prakash Jayabalan, MD
 

Knee osteoarthritis (OA) and cardiovascular disease (CVD) are the two most prevalent medical conditions in individuals above the age of 70. Physical inactivity resulting from OA is known to increase CVD risk in elderly patients and thus shorten their lifespan. Muscle weakness and chronic inflammation are also known to be a significant component of both diseases, and non-steroidal anti-inflammatory drugs (NSAIDs), commonly used to treat OA-related pain are also associated with an increased risk of CVD. Moderate intensity physical activity is strongly advocated for the treatment of both diseases. Randomized clinical trials of walking exercise have shown significant short-term improvements in knee pain, functional status, and quality of life in patients with OA and, in turn, beneficial effects on cardiovascular parameters. However, more recent randomized controlled trials of walking exercise programs in elderly persons with knee OA reported dropout rates as high as 20-40%, indicating reluctance to adopt walking as a lasting form of exercise. Evidence suggests that patients stop exercising due to exercise-induced exacerbation of symptoms, beliefs that exercise could be damaging to their knees, and reduced capacity to perform exercises at intensities and durations recommended, further worsening concurrent CVD parameters. In elderly sedentary individuals with knee OA and CVD, there remains a pivotal need for a physical activity intervention that allows for sustained walking exercise engagement, reducing joint pain and cardiometabolic risk while improving function and cardiovascular parameters.

The study we propose is a randomized controlled trial in individuals with mild to moderate knee OA (n=30 in each group), evaluating the symptomatic, biochemical, and biomechanical benefits of 3 walking exercise treatments: 1) LBPP treadmill walking 2) aquatic walking 3) standard of care land-based walking exercise for the same duration.

Specific Aim 1: Delineate within-participant longitudinal changes in joint pain, quadriceps strength, function (Knee Osteoarthritis Outcome score, KOOS), quality of life (SF-36), NSAID use and serum biomarkers of joint disease, following 12 weeks of off-loaded walking exercise (either LBPP or aquatic walking versus land walking exercise).

Specific Aim 2: Delineate differences in longitudinal changes of cardiovascular parameters (blood pressure, VO2 max, HbA1c and lipid profile) and cardiometabolic markers (serum adiponectin, and inflammatory mediators), following 12 weeks of these respective walking strategies.
 
8. Project Title: Ready for Advances in Bladder health for Older Women (The RAInBOW Study)
  Leader: Emi C. Bretschneider, MD
 

I will develop a patient-centered, individualized overactive bladder (OAB) program uniquely designed for older women that: 1) systematically assesses baseline comorbid conditions and medication use using an integrated online portal-based tool; 2) closely monitors OAB symptoms, treatment response and adverse effects via an online portal-based tool; and 3) proactively adjusts treatments to minimize bothersome OAB symptoms utilizing telehealth visits and expediting the transition to advanced therapies as indicated. I aim to study the impact of this program on patient symptom severity and bother, overall health status and overall quality of life. Over 1-year, women 65 years of age or older with OAB who present to Northwestern’s Integrated Pelvic Health Program (N=60) will be invited to participate in a study comparing outcomes in women (n=30) treated via normal care pathway and (n=30) treated in an OAB program with the integrated online portal-based tools.

Specific aim 1: To develop an online portal-based tool using a human-centered design to systematically assess patient-reported medication use, comorbid conditions and overall health status as well as OAB-condition specific questions such as symptoms, symptom severity, treatment adherence, treatment response, treatment-related adverse effects and patient satisfaction.

Specific aim 2: To perform a pilot study of the online portal-based technology compared to usual care in order to test the usability, acceptability and feasibility of the tool.
 
9. Project Title: Differential Associations Between Spousal Bereavement, Physical Functioning and Health Outcomes Among White and Latino Older Adults
  Leader: Diana Chirinos, PhD
 

Our study will examine how bereavement impacts physical functioning and overall health in a diverse sample of older adults. We will capitalize on two ongoing NIH-funded studies of older adults (5R01HL152442-03) and bereavement (5K01HL149987-03) with harmonized measures and recruit additional bereaved participants (predominantly Latino) allowing us to test novel hypotheses that go beyond the goals of the parent studies. New participants will complete an in-person visit where data on physical functioning, mental and physical health will be collected. In addition, Latino bereaved spouses will participate in an in-depth interview aimed at identifying potential resilience factors during the visit. Individual differences in coping with a loss arise from individual perceptions, social contexts, and cultural beliefs. Thus, Latino culture-specific values (e.g., familism, religiosity) as well as factors such as social support and household composition may play an important role in the grieving process and have a protective effect on the impact of bereavement on physical functioning and health outcomes. Identification of those factors will not only inform our understanding of risk but will also aid in the development of culturally sensitive interventions.

Specific aims:

Aim 1: To examine the association between bereavement status (bereaved vs. non-bereaved), physical functioning (perceived functional limitations), physical (# of chronic conditions, inflammation), and mental health (quality of life, depressive and anxiety symptoms) outcomes among older adults.

Aim 2: To assess differences by ethnicity (Latino vs. NHW) in the association between bereavement status, physical functioning, and physical and mental health outcomes among older adults.

Aim 3. To identify contextual and cultural factors that facilitate coping with bereavement among Latino older adults.
 
DEVELOPMENT PROJECTS (5 Development Projects Listed)
1. Project Title: Minimizing Misclassification of Comorbidities
  Leader: Mary Kwasny, ScD and Laura Curtis, MS
  Core(s): Quantitative and Qualitative Data Analytics Core (Analytics Core)
 
  • Misclassified comorbidities limit accurate estimation of relationships between risk factors and health outcomes. 
  • Comorbidities are often self-reported rather than derived from health records
  • This Development Project combines and expands methods using EHR data (e.g. PheKB) to better classify comorbidities. 
 
2. Project Title: New index representing medical complexity
  Leader: Laura Curtis, MS and Mary Kwasny, ScD
  Core(s): Quantitative and Qualitative Data Analytics Core (Analytics Core)
 
  • Most existing health care indices are either disease specific or designed to assess overall health of the patient
  • This Development Project will create a new index combining the burden of illness in the health care system (e.g. more conditions or providers) and the burden of treatment for the patient (self-monitoring, lab visits, patient's perception).
  • Ultimate goal: better inform the health care system about patient needs to obtain the maximum benefit of health care interactions.
 
3. Project Title: An Individualized, Patient-Centered PRO Monitoring System
  Leader: Eileen Graham, PhD
  Core(s): Patient-Reported Outcomes Measurement Core (Measurement Core)
 

Conduct a DP to build an individualized, patient-centered system for primary and specialist care settings to monitor relevant patient-reported outcomes (PROs) among older adults living with MCC and determine whether PROs can predict clinical outcomes.
 
4. Project Title: Technology-Enabled Primary Care for Mental and Physical Health MCCs
  Leader: Andrew Berry, PhD
  Core(s): Healthcare System & Technology Design Core (Design Core)
 

This Development Project will:

- identify patient barriers to effective communication with internal medicine providers among older adults with symptoms of anxiety and depression and their caregivers 

- develop a low fidelity prototype of a patient organizational system to enhance communication with providers that will be detailed in a design document. 
 
5. Project Title: Summative Design Guideline Development
  Leader: Andrew Berry, PhD
  Core(s): Healthcare System & Technology Design Core (Design Core)
 

This Development Project will: 

- Develop and disseminate a methodology guide that summarizes best practices for applying user-centered design (UCD) to optimize technology-enabled services for older adults with MCC. 
 
RESEARCH (0 Projects Listed)
PUBLICATIONS
2024
 
2023
  1. The Role of BMI in Allostatic Load and Risk of Cancer Death.
    Andrzejak SE, Lewis-Thames MW, Langston ME, Han Y, Khan S, Nettles DA, Fuzzell LN, Tingen MS, Moore JX
    Am J Prev Med, 2023 Sep, 65(3): 417-426
    https://doi.org/10.1016/j.amepre.2023.03.002 | PMID: 36889531 | PMCID: PMC10440242
    Citations: NA | AltScore: NA
  2. Rural-urban differences in personality traits and well-being in adulthood.
    Atherton OE, Willroth EC, Graham EK, Luo J, Mroczek DK, Lewis-Thames MW
    J Pers, 2023 Feb 1
    https://doi.org/10.1111/jopy.12818 | PMID: 36725776 | PMCID: PMC10390645
    Citations: NA | AltScore: 346.56
  3. Development and Validation of the HL6: a Brief, Technology-Based Remote Measure of Health Literacy.
    Bailey SC, Griffith JW, Vuyyuru C, Batio S, Velazquez E, Carpenter DM, Davis TC, Parker RM, Taddeo M, Wolf MS
    J Gen Intern Med, 2023 Feb, 38(2): 421-427
    https://doi.org/10.1007/s11606-022-07739-3 | PMID: 35879534 | PMCID: PMC9311340
    Citations: NA | AltScore: 0.75
  4. Early serum ammonia variation in critically ill patients with cirrhosis: A multicentre cohort study.
    Cardoso FS, Kim M, Pereira R, Bagulho L, Fidalgo P, Pawlowski A, Wunderink R, Germano N, Bagshaw SM, Abraldes JG, Karvellas CJ
    Aliment Pharmacol Ther, 2023 Oct, 58(7): 715-724
    https://doi.org/10.1111/apt.17650 | PMID: 37470277
    Citations: NA | AltScore: 90.45
  5. Post liver transplantation delirium assessment using the CAM-ICU-7 scale: A cohort analysis.
    Cardoso FS, Kok B, Dong V, Kim M, Karvellas CJ
    Can Liver J, 2023 Jul, 6(2): 261-268
    https://doi.org/10.3138/canlivj-2022-0037 | PMID: 37503525 | PMCID: PMC10370723
    Citations: NA | AltScore: 2.5
  6. Editorial: Translational and clinical chronobiology.
    Facer-Childs ER, Kim M, Montagnese S
    Front Physiol, 2023, 14: 1191580
    https://doi.org/10.3389/fphys.2023.1191580 | PMID: 37064922 | PMCID: PMC10090657
    Citations: NA | AltScore: NA
  7. Characterization of pre-operative anemia in patients undergoing surgery by a gynecologic oncologist and association with post-operative complications.
    Foley OW, Vega B, Roque D, Hinchcliff E, Marcus J, Tanner EJ, Barber EL
    Int J Gynecol Cancer, 2023 Jul 9
    pii: ijgc-2023-004539. https://doi.org/10.1136/ijgc-2023-004539 | PMID: 37423639
    Citations: NA | AltScore: NA
  8. The impact of multidrug-resistant microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study.
    Kim M, Cardoso FS, Pawlowski A, Wunderink R, Ladner DP, Abraldes JG, Karvellas CJ
    Hepatol Commun, 2023 Feb 1, 7(2): e0038
    https://doi.org/10.1097/HC9.0000000000000038 | PMID: 36669500 | PMCID: PMC10019237
    Citations: 1 | AltScore: 15.05
  9. The association between light exposure before bedtime in pregnancy and the risk of developing gestational diabetes mellitus.
    Kim M, Facco FL, Braun RI, Wolf MS, Garcia-Canga B, Grobman WA, Zee PC, Reid KJ
    Am J Obstet Gynecol MFM, 2023 Aug, 5(8): 100922
    https://doi.org/10.1016/j.ajogmf.2023.100922 | PMID: 36907513
    Citations: NA | AltScore: 53.43
  10. MidCog study: a prospective, observational cohort study investigating health literacy, self-management skills and cognitive function in middle-aged adults.
    Kim M, Kwasny MJ, Bailey SC, Benavente JY, Zheng P, Bonham M, Luu HQ, Cecil P, Agyare P, O'Conor R, Curtis LM, Hur S, Yeh F, Lovett RM, Russell A, Luo Y, Zee PC, Wolf MS
    BMJ Open, 2023 Feb 23, 13(2): e071899
    https://doi.org/10.1136/bmjopen-2023-071899 | PMID: 36822802 | PMCID: PMC9950895
    Citations: NA | AltScore: NA
  11. Light at night in older age is associated with obesity, diabetes, and hypertension.
    Kim M, Vu TH, Maas MB, Braun RI, Wolf MS, Roenneberg T, Daviglus ML, Reid KJ, Zee PC
    Sleep, 2023 Mar 9, 46(3):
    https://doi.org/10.1093/sleep/zsac130 | PMID: 35729737 | PMCID: PMC9995772
    Citations: 10 | AltScore: 1313.068
  12. Distance and Transportation Barriers to Colorectal Cancer Screening in a Rural Community.
    Lee KMN, Hunleth J, Rolf L, Maki J, Lewis-Thames M, Oestmann K, James AS
    J Prim Care Community Health, 2023 Jan-Dec, 14: 2.15013E+16
    https://doi.org/10.1177/21501319221147126 | PMID: 36594346 | PMCID: PMC9829879
    Citations: 2 | AltScore: NA
  13. Adapting a Research and Community Capacity-Building Program to Address Rural Cancer Burden and Facilitate Partnership Development Between Rural Community Stakeholders and an Urban Comprehensive Cancer Center.
    Lewis-Thames MW, Leahy N, Kruse-Diehr AJ, Ackermann N, Maki J, Davis KL, Drake BF
    J Cancer Educ, 2023 Jan 3, 38(4): 1245-1255
    https://doi.org/10.1007/s13187-022-02256-7 | PMID: 36595213 | PMCID: PMC10315419
    Citations: NA | AltScore: 35.4
  14. Lack of geriatricians in aging-related national media talks.
    Liggett A, Medved D, Lindquist LA
    J Am Geriatr Soc, 2023 Mar 10, 71(7): 2328-2330
    https://doi.org/10.1111/jgs.18313 | PMID: 36898079 | PMCID: PMC10363224
    Citations: NA | AltScore: 35.55
  15. Early COVID-19 Attitudes and Behaviors and Their Associations With Later Infection: A Local Perspective From One U.S. City.
    Light SW, Opsasnick L, Bailey SC, Yoshino Benavente J, Eifler M, Lovett RM, Russell A, Yoon E, McCaffery K, Wolf MS
    Med Care, 2023 Jun 1, 61(6): 409-414
    https://doi.org/10.1097/MLR.0000000000001855 | PMID: 37068043 | PMCID: PMC10167936
    Citations: NA | AltScore: 2
  16. Associations Between Cognitive Impairment Severity and Barriers to Healthcare Engagement Among Older Adults.
    Lovett RM, Benavente JY, Opsasnick LA, Weiner-Light S, Curtis LM, Wolf MS
    J Appl Gerontol, 2023 Jul, 42(7): 1387-1396
    https://doi.org/10.1177/07334648231166289 | PMID: 36987943 | PMCID: PMC10286119
    Citations: NA | AltScore: NA
  17. Association Between Metformin Use and Cognitive and Physical Function in Persons with HIV and Diabetes.
    Masters MC, Granche J, Yang J, Overton ET, Letendre S, Koletar SL, Rubin LH, Brown TT, Tassiopoulos K, Erlandson KM, Palella F
    AIDS Res Hum Retroviruses, 2023 Jun, 39(6): 302-309
    https://doi.org/10.1089/AID.2022.0129 | PMID: 36792952 | PMCID: PMC10278023
    Citations: NA | AltScore: 2.7
  18. Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic.
    Masters MC, Rivera J, Calamari M, Wright K, Janulis P, Rusie L, Bannon J, Milne P, Galvin SR, Molina EG, Hirschhorn LR, Palella FJ, Kumar R, Brown C, Hawkins C
    J Acquir Immune Defic Syndr, 2023 Sep 1, 94(1): 46-52
    https://doi.org/10.1097/QAI.0000000000003238 | PMID: 37368925 | PMCID: PMC10526734
    Citations: NA | AltScore: NA
  19. Subjective cognitive decline and missed aging-in-place/long-term care planning.
    Miller-Winder AP, Schierer A, Relerford RR, Murawski A, Opsasnick L, Olvera C, Curtis LM, Kim KY, Ramirez-Zohfeld V, Lindquist LA
    J Am Geriatr Soc, 2023 May 26, 71(10): 3314-3316
    https://doi.org/10.1111/jgs.18425 | PMID: 37235515
    Citations: NA | AltScore: NA
  20. Challenges and Opportunities in Academic Physiatry: An Environmental Scan.
    Morgenroth DC, Knowlton T, Apkon S, Blauwet CA, Burns AS, Vallejos CC, Frontera W, Hearn SL, Jayabalan P, Lim PA, Moroz A, Perret D, Powell D, Puderbaugh M, Rivers WE, Sowa G, Verduzco-Gutierrez M, Celnik PA
    Am J Phys Med Rehabil, 2023 Feb 1, 102(2): 159-165
    https://doi.org/10.1097/PHM.0000000000002127 | PMID: 36634238 | PMCID: PMC10233907
    Citations: NA | AltScore: 2.35
  21. Transforming a Negotiation Framework to Resolve Conflicts among Older Adults and Family Caregivers.
    Murawski A, Ramirez-Zohfeld V, Schierer A, Olvera C, Mell J, Gratch J, Brett J, Lindquist LA
    Geriatrics (Basel), 2023 Mar 8, 8(2):
    https://doi.org/10.3390/geriatrics8020036 | PMID: 36960991 | PMCID: PMC10037562
    Citations: NA | AltScore: NA
  22. Development and Validation of COVID-19 Vaccine Messaging Materials for Latinx Communities.
    Pack A, Bailey SC, Light SW, Zuleta A, Batio S, Svoboda S, Cross MW, Wolf M
    J Health Commun, 2023 Apr 3, 28(4): 264-271
    https://doi.org/10.1080/10810730.2023.2199255 | PMID: 37038762 | PMCID: PMC10330455
    Citations: NA | AltScore: NA
  23. Current communication practices for biomarker testing in non-small cell lung cancer: Exploring patient and clinician perspectives.
    Pack A, Russell A, Kircher S, Weldon C, Bailey SC, Lockwood K, Marquart T, Afonso AS, Payakachat N, Wolf M
    Patient Educ Couns, 2023 Jun 7, 114: 107839
    https://doi.org/10.1016/j.pec.2023.107839 | PMID: 37321114 | PMCID: PMC10528088
    Citations: NA | AltScore: 5.25
  24. Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
    Patel D, Ng T, Madani LS, Persell SD, Greg M, Roemer PE, Oberoi SK, Linder JA
    Infect Control Hosp Epidemiol, 2023 May, 44(5): 736-745
    https://doi.org/10.1017/ice.2022.164 | PMID: 35822429
    Citations: 4 | AltScore: 25.25
  25. Postoperative complications in women with ovarian cancer stratified by cytoreductive surgery outcome.
    Polan RM, Slota JM, Barber EL
    J Surg Oncol, 2023 Oct, 128(5): 891-901
    https://doi.org/10.1002/jso.27380 | PMID: 37382209 | PMCID: PMC10529113
    Citations: NA | AltScore: NA
  26. Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation.
    Rafferty M, Stoff L, Smith JD, Hansen P, Briody M, Diaz C, O'Donnell L, Heinemann AW, Brown CH, Lieber RL
    Arch Phys Med Rehabil, 2023 Aug, 104(8): 1289-1299
    https://doi.org/10.1016/j.apmr.2023.02.014 | PMID: 36924817 | PMCID: PMC10502191
    Citations: NA | AltScore: 7.4
  27. Development and pilot testing of EHR-nudges to reduce overuse in older primary care patients.
    Rowe TA, Brown T, Lee JY, Linder JA, Meeker D, Doctor JN, Goldstein NJ, Fox CR, Persell SD
    Arch Gerontol Geriatr, 2023 Jan, 104: 104794
    https://doi.org/10.1016/j.archger.2022.104794 | PMID: 36115068 | PMCID: PMC9682472
    Citations: 1 | AltScore: 2.75
  28. Fluctuating decision making about aging-in-place/long term care planning among older adults.
    Schierer A, Miller-Winder A, Murawski A, Relerford RR, Olvera C, Liggett A, Ramirez-Zohfeld V, Lindquist LA
    J Am Geriatr Soc, 2023 Aug 9
    https://doi.org/10.1111/jgs.18536 | PMID: 37555587
    Citations: NA | AltScore: NA
  29. Cognitive Impairment in Liver Transplant Recipients With a History of Cirrhosis: A Systematic Review.
    Siddiqui OM, Baskaran AB, Lin KA, Najam N, Shah T, Beestrum ML, Thuluvath A, Bonakdarpour B, Kim M, Dietch Z, Wolf M, Ladner DP
    Transplant Direct, 2023 May, 9(5): e1479
    https://doi.org/10.1097/TXD.0000000000001479 | PMID: 37096151 | PMCID: PMC10121435
    Citations: NA | AltScore: NA
  30. Patient Perspectives on the Drivers and Deterrents of Antibiotic Treatment of Acute Rhinosinusitis: a Qualitative Study.
    Smith SS, Caliendo A, Cheng BT, Kern RC, Holl J, Linder JA, Cameron KA
    J Gen Intern Med, 2023 Feb, 38(3): 683-690
    https://doi.org/10.1007/s11606-022-07811-y | PMID: 36258155 | PMCID: PMC9971408
    Citations: 1 | AltScore: 0.25
  31. Effect of continuous post-operative lidocaine infusion in an enhanced recovery program on opioid use following gynecologic oncology surgery.
    Taiym D, Cowan M, Nakamura B, Azad H, Strohl A, Barber E
    J Gynecol Oncol, 2023 May 9, 34(5): e61
    https://doi.org/10.3802/jgo.2023.34.e61 | PMID: 37232055 | PMCID: PMC10482581
    Citations: NA | AltScore: NA
  32. Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation.
    Young SR, Lattie EG, Berry ABL, Bui L, Byrne GJ, Yoshino Benavente JN, Bass M, Gershon RC, Wolf MS, Nowinski CJ
    JMIR Form Res, 2023 Jan 10, 7: e42416
    https://doi.org/10.2196/42416 | PMID: 36626223 | PMCID: PMC9875000
    Citations: NA | AltScore: 9.5
  33. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop.
    Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM
    AIDS Res Hum Retroviruses, 2023 Jan, 39(1): 12-Jan
    https://doi.org/10.1089/AID.2022.0079 | PMID: 36322713 | PMCID: PMC9889016
    Citations: NA | AltScore: 3.75


EXTERNAL ADVISORY BOARD MEMBERS

Albert Siu, MD
Mount Sinai Medical Center
Serving since 2021 (3 years)

Catherine Sarkisian, MD, MSHS
University of California – Los Angeles
Serving since 2021 (3 years)

Cynthia Boyd, MD, MPH
Johns Hopkins University
Serving since 2021 (3 years)

Kenneth Covinsky, MD, MPH
University of California – San Francisco
Serving since 2021 (3 years)

Lona Mody, MD, MSc
University of Michigan
Serving since 2021 (3 years)

RECOGNITION AND AWARDS (2023-2024)
MInjee Kim, MD (2023)
  • RCCN Scholar Award
  • Nulliparous Pregnancy Outcome Study – Monitoring Mothers-to-be Heart Health Study 2 (nuMoM2b-HHS2) Scholars’ Award

MINORITY RESEARCH

General Brief Description of Minority Activities:
Not defined.

Minority Trainee(s):
  • Diana Chirinos, PhD, Assistant Professor, Department of Preventive Medicine (Epidemiology)
    Pepper Scholars Program: Differential Associations Between Spousal Bereavement, Physical Functioning, and Health Outcomes Among White and Latino Older Adults
  • Emi C. Bretschneider, MD, Assistant Professor, Department of Obstetrics and Gynecology (Female Pelvic Medicine and Reconstructive Surgery (Urogynecology))
    Pepper Scholars Program: Ready for Advances in Bladder health for Older Women (The RAInBOW Study)
  • Marquita Lewis-Thames, PhD, Research Assistant Professor, Department of Medical Social Sciences
    Pepper Scholars Program: Designing a Telehealth-Based Tool for Rural Older Adults with Cancer and Cancer-Related Distress: Testing for Usability and Acceptability
  • Minjee Kim, MD, Assistant Professor, Department of Neurology
    Pepper Scholars Program: Technology-Enabled Screening Strategy for Obstructive Sleep Apnea (TEST-OSA) in Primary Care Older Patients with Multiple Chronic Conditions
  • Prakash Jayabalan, MD, Assistant Professor, Department of Physical Medicine & Rehabilitation
    Pepper Scholars Program: The Development of Novel Therapeutic Walking Exercise Strategies in Sedentary Individuals with Knee Osteoarthritis
  • Sadiya Khan, MD MSc, Assistant Professor, Department of Medicine (Cardiology) and Department of Preventive Medicine (Epidemiology)
    Pepper Scholars Program: Prevalence of microvascular dysfunction and association with functional limitation in older adults with chronic obstructive pulmonary disease
  • Whitney Welch, PhD, Research Assistant Professor, Department of Preventive Medicine (Behavioral Medicine)
    Pepper Scholars Program: Remote Sensor-Based Frailty Detection in Older Adults

No minority grant information specified.